Transformation is word that tends to be misused, but in the case of Hospital Sisters Health System, it’s an accurate description of what’s happened over the past few years — as the organization completely changed its operating model — and what will continue to happen. One of the key leaders in this transformation is Kevin Groskreutz, who took on the role of Division CIO as HSHS was starting on the journey to becoming a cohesive health system. In this interview, he talks about the “constant conversation” needed to facilitate successful change management, the ever-changing role of IT in enabling change, how HSHS makes its multi-CIO model work, and the organization’s three-year plan. Groskreutz also talks about his own career path, how MU is changing the game, and what it’s like to get 14,000 people to start thinking as one.
- Patient portal challenges — “Acute care data is very episodic.”
- The interoperability puzzle
- 4 HIEs in 2 states
- 3-year plan for IT — “It’s actionable.”
- Selling the benefits of an enterprise approach
- “Success breeds success.”
- The “constant conversation” of change management
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Actually signing up the patients to the portal has been challenging. Most of the interaction for healthcare is with your primary care provider, and so the acute care data, it’s very episodic.
We tend to really focus our revolving IT strategy on a three-year game plan so that it’s fairly actionable and we’re not dealing with a bunch of uncertainties, unknowns, and what if’s.
As we try to move and prepare the organization for population health and more risk-adjusted reimbursement based on managing the whole episode of care, we can share data and work through what that data governance structure looks like, and work with our health partners to try to help position the organization.
It’s a constant conversation regarding the benefits of change, but as you get right down to the financial equation and the impact of that, it starts to become an easier sell.
It’s really fun to watch this organization transform and grow. It’s nice to be part of an organization that has a strong mission and a growth strategy to ensure its future.
Gamble: And are you doing other things as far as patient engagement, whether it’s a portal or any other population health programs?
Groskreutz: We’ve implemented a patient portal with the various different EMRs; we have multiple different patient portals. So our next step is really to improve the product to help engage the patient. It’s a strategy that we’ll develop over the next couple of years, and also to improve the product. Right now it’s fairly basic in its interaction. We have put together a committee of multidisciplinary expertise across the health system and they’re engaging the vendors on functionality and ways to improve that for patient engagement, but it’s one of our key initiatives we’re working on over our three your strategy.
Gamble: And if you’re looking at eventually moving to one record that would certainly help the portal situation as far as having to deal with multiple portals and wanting to have that single record.
Groskreutz: Right. And that would be our intent. We expect to see a lot of progress over the next three years with the product. Because historically we haven’t included a large patient population and medical group and it’s fairly new, the interaction and actually signing up the patients to the portal has been challenging. Most of the interaction for healthcare is with your primary care provider, and so the acute care data, it’s very episodic. You might go to the hospital once in two to three years and most of the time the data is coming from your primary care provider.
In Western Wisconsin, there’s a fairly independent market with ambulatory providers so there’s several different organizations out there. We are feeding their portals with a lot of our data, so the utilization of the portal from the health system is really driven from the ambulatory care side, and that’s where the patients do most of their interacting. From a hospital perspective, we’re doing a lot of data feeds to the different portal technology that’s owned by another partner organization. When I say partner, just in the community sense — they’re independent practices.
Gamble: So through and the telestroke initiative you talked about, there’s definitely a certain amount of reaching out to outside of the organizations to try to make these initiatives work to actually improve patient care.
Groskreutz: Correct. One of the biggest challenges in IT has been achieving interoperability. In working with CHIME and other advocacy groups, we’re pressing to help try to change some of the Meaningful Use policies and regulations and really focusing on whether we can achieve interoperability so that data is easily frictionless between application providers that health organizations may choose to utilize and make that data transition really seamless.
Gamble: Is there a health information exchange either regional or in the state, which I guess is a little tricky since you operate across multiple states.
Groskreutz: There is. We’re actively participating in actually four different exchanges, the primary exchange is Lincoln Land Health Information Exchange. With WISHIN, the exchange in Western Wisconsin, we were going to take a direct feed into it. But because of timing and resources and the effort involved, we focused our efforts down the Lincoln Land Health Information Exchange. That exchange actually is feeding into the WISHIN exchange, which is the Wisconsin Health Information Exchange. And the data from there goes to the other health providers in Wisconsin that are participating in the State Exchange in Wisconsin.
Gamble: Now as far a Meaningful Use, how are you positioned at this point?
Groskreutz: We have attested to stage 2 and we are continuing to monitor the metrics and making sure that we can sustain those results. We’re in really good standing there.
Gamble: Okay. So before we move on, I want to make sure there wasn’t anything else as far as immediate projects on your plate. Have we pretty much covered what’s on your agenda?
Groskreutz: Yeah. Most of my agenda for the next three years — and I keep saying three years because we tend to really focus our revolving IT strategy on a three-year game plan so that it’s fairly actionable and it’s something we can take action on, and we’re not dealing with a bunch of uncertainties, unknowns, and what if’s. It helps drive that focus for the organization, which is good. But a lot of my effort really involves changing the IT systems to enterprise architectures and consolidating departmental applications, and implementing standard platforms. As a health system that has developed over hundred years independently, each hospital has our own departmental applications where we have put together functional groups across the health system, meaning we have representation from each hospital participating and helping evaluate IT applications. And then as the existing applications age or become end of life, we implement the go-forward strategy or solution, so that’s really been a lot of the focus.
We are also working on business intelligence. So as we try to move and prepare the organization for population health and more risk-adjusted reimbursement based on managing the whole episode of care — inpatient, ambulatory and long-term care — we can share data and work through what that data governance structure looks like, and work with our health partners to try to help position the organization to be prepared for the continuing evolution of the healthcare reimbursement model.
Gamble: It’s interesting to me that when you talk about the three-year plan and then also that the transformation the organization has undergone over the past four to five years, I can imagine there’s been a really big emphasis on change management and just a change in thinking. I just wanted to kind of get some of your thoughts on that and what it has taken to get all of these different people, different departments to see things in a new way.
Groskreutz: The change management processes has taken a lot of effort, a lot of time, and focus. I spend the majority of my time articulating the benefits of an enterprise approach and the financial impact to the organizations to do that. Actually, once you get through the clinical perceived differences of, ‘I have one application and I like it,’ or ‘I think it’s better versus this other application,’ and of course as you work with different entities that like the application they’re using. It’s a constant conversation regarding the benefits of change, but as you get right down to the financial equation and the impact of that, it starts to become an easier sell to the organization that this is a must-have as we move forward with decreasing reimbursements that we should go down a path of standardization. Some health systems —and when I say health systems, I mean hospitals within the system — have really increased their IT services that they couldn’t afford before, because as we enterprise our application, they become more economical to afford and deploy that they’ve seen an increase in services. So some of our smaller sites have much more IT applications that are driving the clinical workflow and improve clinical workflows that they simply couldn’t afford before. So that’s been a great win too, and they become some of our strongest advocates to help sell that change.
Gamble: Yeah, I can imagine that.
Groskreutz: Success breeds success. As you have one story that has been positive, it really lends itself to the next group, and so on. It’s become a lot easier over the last three years.
Gamble: It’s been a gradual change in culture.
Groskreutz: It has been. It really has been. I like to see that. It’s really fun to watch this organization transform and grow. It’s nice to be part of an organization that has a strong mission and a growth strategy to ensure its future.
Gamble: I can imagine that’s a helpful selling point too to have when you talk about the three-year plan. Like you alluded to, it’s not something where you saying, ‘this is what we plan to do eventually.’ And I think it becomes a little more tangible when you have that kind of timeline.
Groskreutz: It does. We keep updating our roadmaps and sharing them with our stakeholders and continue to profess the claims of enterprise approaches to most everything IT. We’re in an age of healthcare IT where there are not many initiatives that do not have an IT component to it that the health system takes on. IT has really expanded its integration into all of the various different departments across each hospital or within each hospital.